Itemized Bills Required for BlueCard® Facility Claims over $100K

Sept. 28, 2020

Beginning Jan. 1, 2021, we will require facilities to submit an itemized bill for inpatient care billed for $100,000 or more. This applies to all facility claims for $100,000 or more submitted for BlueCard out-of-area Blue Cross and Blue Shield members. An itemized bill helps ensure an accurate claim payment and reduces the need to submit more information after a claim is paid.

What’s Changing
The BlueCard claim amount requiring itemization will be lowered to $100,000 from the current $200,000 threshold.

How to Submit Itemized Bills
You may submit itemized bills electronically using our Claim Inquiry Resolution tool. Include the corresponding claim number for quicker review and turnaround time.

More Information
Refer to our CPCP002 Inpatient/Outpatient Unbundling Policy on the Clinical Payment and Coding Policy page on our provider website for more information. If you have any questions, please contact your Blue Cross and Blue Shield of Texas (BCBSTX) Provider Network Representative.